Provider Demographics
NPI:1285119107
Name:MEEHAN MOULTON, PAMELA ANNE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:MEEHAN MOULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9748 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8606
Mailing Address - Country:US
Mailing Address - Phone:707-328-0026
Mailing Address - Fax:
Practice Address - Street 1:9748 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8606
Practice Address - Country:US
Practice Address - Phone:707-328-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool